Wednesday, May 13, 2009

You Have Now Been Sampled


While the pharmaceutical industry’s image and reputation has and appears to continue to suffer, added damage has expressed itself with costly patent expirations with certain large corporations within this industry in particular.

As the president of the lobbing group for the industry which is called PhRMA would likely concur to a degree if asked, the image of this industry has experienced noticeable trauma over the past two decades in particular, and cannot be repaired by the pharmaceutical industry’s lobbying group.

The atrophy of the image of the pharmaceutical industry is largely due to how they market and sell their medications. Let’s take branded drug samples as an example:

Even though the ability for health care provider to request samples of a pharmaceutical company’s medications online by request which would bypass the company’s representatives is done with smaller drug companies, and apparently is legal, the pharmaceutical industry, overall, prefers to have their own representatives dispense samples of their promoted medications.

These sales forces of pharmaceutical companies have been examined more now than in the past by others due to their unbelievable size, for one reason. The number of representatives of these sales forces of large pharmaceutical corporations tripled within a decade- starting in the mid 1990s.

Also, the estimated total income for an individual pharmaceutical representative may exceed 200,000 a year, if benefits and perks are factored in to this cost. Overall, the amount spent on these drug representatives exceeds 20 billion dollars annually by the pharmaceutical industry.

Sadly, yet with a high degree of confidence, most big pharmaceutical sales representatives are viewed and evaluated by their employers as it relates to their ability to gift targeted prescribers- to reward them for prescribing their promoted products.

This is due to the large number of representatives promoting the same medications to the same doctors who work for the same pharmaceutical company.

In fact, one could conclude that an individual representative in such a work environment with multiple partners with their employer is, or could be, potentially exonerated from any individual responsibility in regards to their vocation.

This is why they may be judged by their employers according to how much of their employer’s monetary ‘marketing budget spend’ one individual drug representative dispenses to targeted prescribers in a certain period of time. This will be further addressed later.

Yet these inducements are never described by what they actually are, which are bribes. Who receives these bribes is largely determined by the volume of scripts the prescriber writes as it relates to the pharmaceutical company’s promoted products. The drug companies know who these prescribers are thanks to the American Medical Association (AMA).

The AMA sells to the drug companies identifying information on each prescriber to the drug company. As a result, the drug company can track the prescribing habits of individual prescribers.

Therefore, the gift dispensing is determined by the prescriber’s loyalty to a particular pharmaceutical company’s products.

However, and empirically, the drug sampling of doctors may be considered the ultimate if not primary gift that influences the prescribing habit of a health care provider.

Some pharmaceutical representatives are falsely led to believe that their territory’s performance is due in large part to their powerful ability to influence others, as they view themselves as outstanding salespeople.

Although such pharmaceutical representatives want to believe such a false premise, it is samples of medications that determine the prescribing habits of health care providers, and this has been proven.

Many years ago, drug representatives did in fact use their persuasive, yet ethical, abilities to influence the prescribing habits of doctors in an honest and credible manner. They focused on the benefits of their promoted medications for the doctor’s patients.

However presently, most health care providers now simply do not allow drug representatives to speak with them, or even see them, because the paradigm had become darker than it was in the past regarding their benefit to them.

Medical establishments are progressively and completely banning drug representatives from entering their medical facilities. This is happening for several reasons, which include the following:

The health care providers lose money. They are normally busy, so their time is valuable. As a drug representative, you are an incredible waste of their time. Yet they will accept your samples still.

The credibility you possibly have thought you had and were perceived as such by doctors as a drug representative is no longer viewed to exist to any noticeable degree by the prescriber.

Also, the accurate perception of the prescriber is that now pharmaceutical representatives are more concerned by their financial health instead of the health of the provider’s patients.

The health care providers do not find the pharmaceutical representatives with the knowledge they need to benefit their understanding of the drugs that the representatives promote.

Any information shared by the pharmaceutical representative to them, either oral or written, is likely embellished if not fabricated.

This view is due to the frequent statistical gymnastics the employers of drug representatives engage in way too often with their promoted products, and the representatives are likely unaware of the data they have is as inaccurate as it is.

Doctors by their very nature seek answers objectively. And doctors do in fact find out about drugs through other methods besides the representative who promotes particular drugs.

This is further illustrated by pharmaceutical representatives being selected by pharmaceutical companies due to their perceived appearance and personalities judged by certain hiring managers of various pharmaceutical employers. The focus should be on the candidate’s clinical knowledge and understanding instead.

Another trait desired by the pharmaceutical company is the potential candidate’s likelihood of being completely obedient to their directives, as well as their affinity for monetary gain.

Qualities related to anything of a scientific, medical, or clinical nature is of little if any concern to most pharmaceutical companies, quite apparently.

This is why pharmaceutical representatives have little if any interest or concern regarding public health, perhaps. This premise is further validated by the pharmaceutical employers’ minimal concern regarding the medical knowledge of their sales representatives, as mentioned earlier.

What the pharmaceutical company is concerned with, however is the ability of their representatives to effectively offer inducements to targeted prescribers. The inducements are not gifts, but are bribes, once again.

Examples may be creating a check from the pharmaceutical representative’s employer to be issued to one of the targeted prescribers determined by the pharmaceutical company. This check, when given to such a prescriber, is often for doing little, if anything at all for the pharmaceutical company paying such a prescriber.

Knowing this, it seems to validate the pharmaceutical industry’s overt apathy regarding this industry’s absence of focus regarding the essential medical knowledge of their sales representatives, and the knowledge of the power of inducements instead.

In relation to non-monetary inducements given to certain prescribers, they are valuable and at times without any clear medical benefit for the prescriber. Examples may be televisions, or DVDs.

Since pharmaceutical representatives understandably believe that since they are given such directives by their pharmaceutical employers to dispense these inducements, then they must be legal and ethical.

This is further reinforced by the applause and rewards the pharmaceutical representative receives often for this behavior of giving bribes to prescribers. They are viewed by their employers as innovative and creative, instead of criminal.

The situation appears to eliminate the need or desire for the pharmaceutical representative to examine the consequences potentially of some activities and tactics encouraged by their pharmaceutical employers. It is clear that most pharmaceutical representatives do not question what they are told to do.

Targets determined by a drug company are a result of what is referred to as data mining. This is a primary variable as it relates to who a pharmaceutical maker may choose to support financially in one way or another.

Prescribing data is in the possession of pharmaceutical companies of the prescribers nationwide, and this data is analyzed to determine the prescribing habits of health care providers. This prescribing data is provided to the pharmaceutical companies by the American Medical Association, as mentioned earlier.

Further disturbing is the fact that this behavior is not prevented or deterred by our lawmakers. For example, this data mining allows a pharmaceutical company to conclude who could potentially affect their business.

So the data allows drug companies to dispense gifts to the right prescribers for their business they are giving the drug company. The gifting establishes reciprocal relationship with the receivers of these bribes. Quid Pro Quo is now born, and the pharmaceutical company continues to thrive.

Conversely, if a prescriber is determined by a pharmaceutical company to be harmful or of minimal financial benefit to their business, they will essentially be ignored and ostracized by the pharmaceutical company.

While such unethical activities may appear to be ridiculous and without reason to some, this does not mean they do not occur. The illegal and unethical behaviors of certain pharmaceutical companies seem to be rather unbelievable by others on occasion.

It seems that external regulation is necessary to prevent the drug companies from allowing this corruptive autonomy to continue to exist. It is rather obvious that internal controls of companies that perform such wrongdoing are void of self-regulation with deliberate intent.

If regulation happens, then health it may be possible to resurrect the ethical element necessary as a participant in the health care system. The importance of public health should be the apex of their existence as a company that participates in this system.

Overall, pharmaceutical representatives are decent and intelligent people who do not realize the results of the actions they perform upon direction are harmful to the health of others. And if they may do in fact realize what they do for their pharmaceutical employers is in fact wrong, they continue to please their employers, as financial benefit for them outweighs the results of their actions.

Fear ensures loyalty.” --- Author unknown

Dan Abshear

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1 comment:

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